immunosuppressant inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines. Reduces function of cells which are causing inflammation and should help relieve pain from joint damage (RA)

rheumatology Flashcards by Roxanne B

what key features should be considered in the design of the practice and it’s facilities to enable those with limited mobility to access your GDP

Ramp access - temporary or permanent
Space for wheelchair turning circle/wheelchair in and out (less space)
Parking nearby - disabled priorty
- Unlikely in high street
Lowered pavements at junctions - wheelchairs, mobility scooter
State pavement in - potholes, cracked, wobbly, moss covered (slippery when wet)
Grab rails - handles to help
Button to open door (door open in the way), handle at appropriate height if not
Reception desk at height that is good for wheelchair
Uncluttered corridors
Disabled toilet facilities

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do you feel you have a responsibility to facilitate access to healthcare facilities for pts?

yes - moral

but sensible - may not be feasible

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any legislative framework which exists to enable the access and provision of care for all individuals and groups of people

equality act 2010 (wider umbrella than previous Disability Discrimination Act (DDA))
- protected characteristics
AWI act
Mental health act

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9 protected characteristics of equality act 2010

age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation

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reasonable adjustment

is a change to remove or reduce the effect of disability

positive action to help someone with protected characteristics

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example reasonable adjustment for GDP

Ramp is steps into surgery entrance, installing handrails
Loop system for hard of hearing
Clearer signage
Layout of practice so suitable turning for wheelchair

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example unreasonable adjustment GDP

If surgery is situated up the stairs in old building installing a lift as be too expensive to justify

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what would you do if unable to make any reasonable adjustments to enable someone with disabilites to enter your practice

if not registered

Apologise
Refer/suggest other dentists in the area who will be able to facilitate her

if regestered already

your responsibility to transfer them to new suitable practice
not just signpost

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possible options to aid transfer to chair

Hoist
Transfer boards
Pt turners / turn table
Wheelchair recliner
Reclining wheel chair - need temporary head rest

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hoist

benefits and cons

Unlikely to get in GDP

Portable - big and bulky, space
when not in use - hoist needs to be in docking station for charging

need pt sitting in sling when they arrive in wheelchair

single use
different sizes
- comes up to back of head - stiffened there
ensure right sling for hoist (attachments)

Pt may not feel comfortable/at ease using it

scary 1st time

need to 2 people to operate (maybe 3 depending on pt size)

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transfer boards

Need a break leg facility or knee break

Not whole seat conventional dental chair

Wheelchair close to chair

Breaks on

Slide under pt and onto dental chair

Pt needs t be able to them self - upper body strength - risky

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reclining wheelchair

cushions on chair to make pt more comfortable - ease pt pain and discomfort (can be more sensitive)

good as not compromising dentist’s posture

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turn table

Need to be able to stand and support their weight

Usually 2 people to support

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wheelchair recliner

best

but bulky, expensive

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stand aid

like turntable but more supported

need 2 carers to support

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considerations for someone with reduced mobility when planning appointment length

How long has it taken to get her into practice, out of wating room into chair

Probably need to give them longer appointment for mobility

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social history importance for someone with restricted mobility/disability

travel
support at home
- carers - when (time around) (first thing not ideal as often longer to get going)
diet
alcohol

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medical history importance for pt with disability/restricted mobility

past and future hospital stays
medications,
is it stable
prognosis

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methotrexate

immunosuppressant

inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines.
Reduces function of cells which are causing inflammation and should help relieve pain from joint damage (RA)

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link between sjorgens and RA

RA - autoimmune disease, so is sjorgen

get one likely to get the other

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predisnolone

corticosteroid

systemic

dampen down inflammation (RA)

risk of corticosteroid and dental tx

need to know even if long time ago (months) - ask dose as can still be concern

dampen down inflammation

need body to be able to make cortisole - but will stop if on corticosteroid dose for long time (lose fight/flight response - may need to top up for tx)

primary sjorgen

dry eyes and mouth

secondary sjorgens

dry eyes and mouth with assoicated disease

if pt says they have dry mouth want info do we want

* Wan to know how long experience symptoms * Has she got eye symptoms * referral --\> risk loss sight * Does she have sensation of sand/gravel in eyes * How severe oral symptoms * impacts everday life * swollen glands - recurrent or persistantly * Drink liquid to aid swallowing * Salivary flow rate - normal, stim and unstim * Blood test

blood test for sjorgens and RA

autoantibodies SS-A/Ro and SS-B/La and rheumatoid factors (if RA) indicates CT disease (RA, SLE, sjorgen)

hands of RA pt

twisted claw like grip issue - toothbrush

impact of dry mouth on tooth hard tissue

demineralise acidic environment

differential dx for dry mouth (10)

* Medication * Polypharmacy * Endocrine disease - *diabetes* * Anxiety stress * Dehydration - starvation * Cancer therapy * transient dry mouth in chemo, * radiotherapy - glands irritated - profound chronic and progressive dry mouth (fibrosis of tissues) * Heridiatry causes * Cystic fibrosis * Inflammatory - *lupus, sarcoid, sjorgen* * Infections - *HIV, hep C, epstein barr*

ramfjords teeth

16, 21, 24, 36, 41, 44

BPE2

supra or sub gingival plaque/calculus no probing depths \>3.5mm

BPE3

supra or sub gingival plaque/calculus probing depths between 3.5-5.5mm

BPE4

supra or sub gingival plaque/calculus probing depth 6mm or more (black band entirely in pocket)

BPE \*

furcation involvement

tx BPE2

plaque and gingivitis chart OHI remove supra- gingival calculus and plaque and sub gingival if present

tx BPE3

6PPC if more than one sextant plaque and gingivitis chart OHI remove supra- gingival calculus and plaque and sub gingival if present RSD

tx BPE4

6PPC plaque and gingivitis chart OHI remove supra- gingival calculus and plaque and sub gingival if present RSD assess need for complex tx referral

tx BPE \*

assess need for complex tx referral

which radiograph to take for RA pt

OPT maybe more comfortable if reduced opening not ideal when pt in wheelchair (better if standing and supported) maybe size1 PA of anterior teeth id OPT not adequate

consideration for tx planning for someone with restricted access

how can we minimise appointments - quadrant or arch approach possible ?

endo for restricted access pts

demanding, several tx so not ideal options for access

why may a pt have a particular area of worse perio health if have RA

may find that area particularly hard to clean e.g. right handed lower if right handed

questions to ask about access

How easy to get How regularly will she be able to come Would she need accompanied Best time for her for appt

autoimmune disorders and maligancy

possibility of malignant change in autoimmune disorders b cell lymphoma and sjorgens

xerostoma and infections

more likely with sore mouth * Fungal - acidic dry mouth * Staph aureus - sialitis - red swollen shiny hot cheek if parotid (antibiotics) less common in submandibular

when tx planning for restricted access pt consider

how to carry out tx * pt level fatigue * prop needed * sedation - muscles relax better - possible better access?

long term tx planning for pt with RA

* Stability of disease * Rate of dental disease - are we getting control of her dental disease * Frequency of check ups post tx plan * 3 months (idea getting on top of disaese - managing prevention) * Complications of sjorgens * chronic progession condision * Caries - demin teeth * Gingiva sore inflammed * Denure - can she use - saliva, putting it in and out

aids for toothbrush dexterity

* electric? * adapt handle * foam * putty handle * acrylic lab made handle * curve toothbrush * multiple sided

denture cleaning aid for reduced dexterity

denture hold to aid cleaning made so denture face sits one for fitting surface, other for outer surface

immunosuppressant risk

infection depend on dosage likely drug interactions